9%20ECOGRAFIA%20ABDOMINAL%20COMO%20CUANDO%20DONDE

32
ABDOMINAL ULTRASOUND
Figure 2.32 A contracted, thick-walled gallbladder
located in the gallbladder fossa on TS.
Figure 2.34 CBD at the porta hepatis. The lower end is
frequently obscured by shadowing from the duodenum.
The duct should be measured at its widest portion.
A
the common bile duct, because we can’t tell at what
point it is joined by the cystic duct.
The extrahepatic portion of the duct is less easy
to see as it is often obscured by overlying duodenal
gas. Good visualization of the duct usually requires
perseverance on the part of the operator. It is insufficient
just to visualize the intrahepatic portion of
the duct, as early obstruction may be present with
a normal-calibre intrahepatic duct and dilatation of
the distal end. (Fig. 2.35).
B
Figure 2.33 (A) The duodenum frequently invaginates
the posterior wall of the gallbladder and may mimic
pathology if the machine settings are not correctly
manipulated. (B) Fluid-filled stomach near the
gallbladder fossa mimics a gallbladder containing a
stone. The real gallbladder was normal.
the vein and the duct (Figs 2.20A and 2.34), although
a small proportion of hepatic arteries lie anterior to
the duct (Fig. 2.20B). At this point it is usually
referred to as the common duct, although it may, in
fact, represent the right hepatic duct 7 rather than
Figure 2.35 Visualization of the lower end of the duct
often requires the operator to persevere with technique
and patient positioning. The normal duct (calipers) is
seen in the head of the pancreas.